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1、BISPHOSPHONATERELATED OSTEONECROSISOFTHE JAW(BRONJ)BISPHOSPHONATESANDWHATHAPPENSTOBONEVINCENTE.DIFABIO,DDS,MSMEMBEROFTHECOMMITTEEONHEALTHCAREANDADVOCACYFROMTHEAMERICANASSOCIATIONOFORAL&MAXILLOFACIALSURGERY(AAOMS)ASSOCIATEPROFESSOROFORAL&MAXILLOFACIALSURGERYUNIVERSITYOF
2、MARYLAND,BALTIMORE,MARYLANDANDPRIVATEPRACTICEOFORAL&MAXILLOFACIALSURGERY,FREDERICK,MARYLANDBISPHOSPHONATESANDWHATHAPPENSTOBONEPRESENTTHEPOTENTIALFORADIFFERENTETIOLOGYOFBONEDESTRUCTIONINTHEMAXILLAANDMANDIBLEANDTHENEEDFORSPECIFICCODESTOREPRESENTTHISDIFFERENTETIOLOGYOFBON
3、EDESTRUCTIONSEENINTHEMAXILLAANDMANDIBLEOSTEONECROSISOFTHEJAWNOTANEWDISEASEORPHENOMENON“PHOSSYJAW”DATESBACKTOTHE19THCENTURYRELATEDTOMATCHSTICKMAKINGHIGHLEVELSOFPHOSPHORUSBISPHOSPHONATESAREUSEDTOTREATSEVERALDISEASEENTITIESOSTEOPOROSISCANCERPATIENTSRECENTPAPERSHAVESHOWNTH
4、ATAJAWOSTEONECROSISOFASEPTICETIOLOGYISASSOCIATEDWITHTHEUSEOFBISPHOSPHONATESOSTEOPOROSISTREATEDWITHBISPHOSPHONATES(BPs)MANYPEOPLEWORLDWIDEARERECEIVINGTHESETYPESOFMEDICATIONSISTHISTREATMENTOFOSTEOPOROSISWITHBPsOFCONCERN???OsteoporosisPrimarydisease:quantitiesofsexhormone
5、sPhase1:trabecularboneresorptionduetoestrogendeficiency.Peaksafter4-8years(womenonly)Phase2:persistent,slowerlossofbothtrabecularandcorticalbonewhichismainlyduetodecreasedboneformation(menandwomen)OsteoporosisSecondarydisease:consequenceofotherdiseasesormedicationsLong
6、termsteroiduse,Cushing’sdisease,anorexianervosa,athleticamenorrhea,HPT,cysticfibrosis,inflammatoryboweldisease,rheumatoidarthritisObservedinyoung/old,men/womenOsteoporosisICD-9-CMCodes:733.0–733.09OsteoporosisUnbalancedboneremodelingwhereboneformation=boneresorptionDef
7、inedasadiseasewithlowbonemassanddeteriorationofbonestructureresultinginbonefragilityandincreaseriskoffractureFemales>>>MalesPrimaryvs.SecondaryLernerAH,J.DentRes85.2006OsteoporosisisaBIGproblemintheUSA!SurgeonGeneralReport(2004)40%ofAmericanwomen>50yo.Willexperienceano
8、steoporoticfracture13%ofmen50yo.By2020itisestimatedthat50%ofallAmericansovertheageof50willbeatriskofdevelopingosteopo
